I've encountered a fair amount of confusion about the abortion language the House actually adopted on Saturday. Read it for yourself here -- it's a little more than three pages in large type, much of it spent removing abortion-related provisions in the underlying bill. The amendment by Bart Stupak (D-Mich.) and Joe Pitts (R-Pa.) would restrict only the new insurance marketplace (a.k.a. the "exchange") that the bill would create for uninsured individuals and small businesses. It would have no direct effect on the group insurance policies that cover many American workers and their families. Whether it would have an indirect effect on those policies, however, is an open question. Feel free to offer your speculation in the comment section below.

Specifically, the Stupak amendment would prohibit federal dollars from being used to buy any policy offered through the exchange that covered abortions other than those related to rape, incest or danger to the mother's life. It also would require insurers that offered elective abortion coverage through the exchange to also offer policies "identical in every respect" except that they did not cover such abortions.

The main effects of the amendment would be to stop anyone receiving a federal subsidy from buying a comprehensive health insurance policy that covered elective abortions, and to bar the proposed government-run insurance plan (a.k.a. the "public option") from covering such procedures. The amendment would allow insurers to offer "supplemental" policies that covered abortions, but their customers could not use federal subsidies to buy them.

Prior to the Stupak amendment, the House bill would have required insurers to jump through some accounting hoops to segregate the money collected for coverage that was mandated by the bill -- and eligible for subsidies -- from coverage for elective abortions. But abortion opponents argued that this arrangement didn't go far enough. Money is fungible, after all, and making the mandatory coverage more affordable with subsidies would also make any additional coverage more affordable.

The same argument applies to the Stupak amendment. The Stupak language would require women seeking coverage of elective abortions through the exchange to sign up for a separate policy, potentially (but not necessarily) forcing them to spend more for the two than they would have spent on a single plan that included the coverage. Of course, their ability to afford the supplemental coverage would be greatly enhanced by the federal subsidies that shrink the cost of the main plan.

So why is the pro-life camp so enthusiastic about the amendment? Maybe they expect it to lead insurers to stop offering any kind of coverage for elective abortions through the exchange. That's what Planned Parenthood and its allies fear. These advocates complain that insurers wouldn't offer the supplemental coverage because there wouldn't be enough demand, given that abortions result from unplanned pregnancies. I'm not so sure about that -- no one plans to get sick or break a bone either, and yet everyone who buys health insurance wants to be covered for such things.

It's also worth noting that although many insurance policies cover elective abortions today, a high percentage of them aren't paid for by insurers. In addition, 17 states use their own Medicaid budgets to pay for "medically necessary" abortions for poor women.

So the Stupak amendment may not have much effect on the poorest women in states such as California, women covered by group insurance policies, or women of means. But it's undeniable that the amendment threatens the availability of insurance coverage for elective abortions for the working poor and lower middle class -- the ones who would receive subsidies under the House bill to buy insurance through the exchange. That category includes those making 150% to 400% of the federal poverty line -- up to $43,000 for a single woman.

Updated, Wednesday at 3:27 p.m.: I see from the comments left by Karen, Nate and a few others that I shouldn't have referred to abortions not covered by the so-called Hyde amendment restrictions (i.e., to terminate pregnancies not caused by rape or incest and not needed to save the mother's life) as "elective." My bad. The non-Hyde category includes abortions that would be deemed "medically necessary," which is a very broad classification. In fact, some abortion opponents view "medically necessary" as a loophole so wide, it opens the door to abortions for practically any reason.

-- Jon Healey

Public option, shmublic option. If you really want to get people worked up about healthcare reform, start talking about whether it should cover abortions and illegal immigrants. Today, the editorial board tackles both those issues, saying that abortion opponents are looking to "extend federal prohibitions into private pocketbooks. By restricting coverage offered through the exchange, they hope to make abortion coverage so unattractive that insurers eventually stop offering it in the market for individual and small-group policies." Healthcare reform thus should not restrict those who receive subsidies from buying extra coverage for abortions. And it's an odd healthcare policy that would eliminate all possibility for illegal immigrants to participate in subsidized care, but require them to purchase their own coverage regardless of their personal finances, the board argues.

"Extraordinary rendition" is just a dressed-up word for kidnapping in the editorial board's eyes, and it praises Italy for recognizing that fact, if mainly symbolically, by convicting 23 Americans and two Italians in absentia for grabbing an Egyptian cleric in Milan six years ago.

On the other side of the fold, the author of a book on the Cold War argues that former President  Reagan's seemingly bold words to Mikhail S. Gorbachev --"Mr. Gorbachev, tear down this wall." -- were for the most part a cover intended to build popular support for the president while he worked on effective diplomatic relations with the then-Soviet president.

And writer Joe Mathews raises his hand for the job of lieutenant governor. It's not that he has ambitions to run anything, he says, and that's exactly what qualifies him for the job. Meanwhile, think of all the spare time he'd have for blogging.

-- Karin Klein

Photo: People stroll by the giant dominoes set up at the site of the Berlin Wall, part of a gala celebration of its toppling. Credit: Fabrizio Bensch / Reuters

I had surgery not long ago, and the actual surgery itself didn’t take a fraction as much time as all the insurance wrangling and worrying did.

At one point, when I was trying to negotiate the massive gap between what the out-of-network anesthesiologists charge and what my insurance would pay, I finally said that I’d just bite down on a wooden spoon during the surgery –- and I’d bring my own spoon, so I wouldn't get charged for that, too.

Whatever the doctor thought, I figured I couldn’t get the surgery until I’d figured out how much I’d have to pay, and whether I could afford it –- or whether I should just wait until things got so bad I’d just check into the emergency room, and they’d have to pay for it.

But all of it gave me an idea.

"House" is a rare TV show I’ve watched with pleasure, in part because there’s the splendid Hugh Laurie, and in larger part because it’s so much like my beloved Sherlock Holmes: House/Holmes, aided or on occasion challenged by Wilson/Watson, solves the most mystifying conundrums in the world of medicine/crime.

But the series is starting to get a wee bit stale, and I think I know how to fix it, and fix it in a way that will illuminate the problems of our present healthcare system, too.

Every show involves massive amounts of medical diagnostics and treatment –- MRIs galore, CAT scans, arcane tests I’ve never heard of, as the patient lies expensively tethered to monitors and tubes for weeks at a time.

And I don’t think I’ve ever heard any test the doctors have ordered not being done because of how much it costs.

TV isn’t supposed to be realistic, but even a good drama could use a little more drama. So here’s my idea: a new addition to the regular cast. The head guy in the hospital's insurance office.

What insurance policy would pay for all that treatment and hospital time? What hospital could pick up the tab for all of that platinum care? When the opponents of healthcare reform moan about "rationed care," all I can say is that it’s already rationed: I have a lifetime dollar-figure cap. When I hit that, they unplug me and roll me out the door, unless I can pay the tab myself.

So if "House" is going to treat us to real diseases and diagnoses, it ought to show us some real insurance controversies. The cast-member naysayer and House could mix it up, fight over that third MRI in a week, come to blows, make up over beers -– all about deductibles and out-of-network coverage. And you’re welcome, Fox TV –- you can send the check to me right here.

[While I have the attention of the health-minded, I’d like to quibble with the Centers for Disease Control and Prevention websites exhorting the potentially flu-stricken to "cough or sneeze into your elbow." This, as the good doctors know, is physiologically all but impossible. In a world where eardrops have to come with instructions to users to put the drops in the ear, better they should be telling people to sneeze or cough into the crook of the arm. And, yes, that either arm will do.]

-- Patt Morrison

Columnist Jonah Goldberg foresees clouds ahead for the Democrats -- in fact, a coming storm so severe that it could end Democratic control of Congress. It's building from the Tea Party movement, which Goldberg sees as an heir to the Ross Perot third-party movement of the 1990s. "If the GOP can convincingly align with and exploit the growing Perotista discontent, it very well might ride to victory on a tsunami the Democrats can't even see."

Also on today's Op-Ed page, scholar Giles Dorronsoro explains why U.S. attempts to win hearts and minds in Afghanistan's Pashtun areas in the south and east are probably doomed to fail. And ACLU National Security Project chief Jameel Jaffer decries an attempt by Congress to circumvent the courts by giving the secretary of Defense the power to withhold photographs of combatants "engaged, captured or detained" by the U.S. during the Bush administration.

On the Editorial page, The Times weighs in on Atty. Gen. Eric Holder's policy change on medical marijuana. Though we're happy that federal prosecutors will make marijuana cases a low priority in states like California that have passed laws approving its medicinal use, we think that's the wrong approach. The administration shouldn't be picking and choosing states in which to enforce federal law -- rather, it should de-emphasize medical marijuana cases in all 50.

We also note that the best place for local health departments to conduct swine flu vaccinations is at public schools -- yet that's not where the inoculations will take place in Los Angeles, thanks to a failure by the school district and the county to properly coordinate.

And we muse on the bizarre spectacle presented by Colorado's Heene family, accused of perpetrating the "balloon boy" hoax in an attempt to drum up publicity for a reality show. "As much as some people will do just about anything for a Hollywood contract, a good number of the rest will lap up the juicy story of their wrongdoing. In reality, perhaps we all get what we wanted."

Illustration by Jonathan Twingley / For The Times

Columnist Tim Rutten notes the recent complaints about the California initiative process by the state's chief justice and a top fund manager and asks, what to do? The answer is, umm, unclear:

Also on the Op-Ed page, James D. Zirin, a member of the Council on Foreign Relations, urges President Obama to hurry up and appoint a cyber security czar because the risks are so great. And hey, you can never have enough czars! And author Barbara Ehrenreich scoffs at a recent study, "The Paradox of Declining Female Happiness," that "purports to show that women have become steadily unhappier since 1972." Says Ehrenreich:

On the editorial pages, the board blasts the health insurance lobby for hiring PricewaterhouseCooper to do a hatchet job on the Senate Finance Committee's healthcare reform bill. But it admits that the insurers have a point: The bill falls critically short of the goal of providing universal health insurance. And it argues that the recent botched execution in Ohio, the latest in a string of similar incidents in that state, adds to the evidence that lethal injections don't pass constitutional muster.

Photo credit: Susan Tibbles / For The Times

-- Jon Healey

From the start of the buzz about Gardasil, the vaccine that guards against the two most common forms of the virus that can cause cervical cancer, I've wondered why public health officials were concerned only about vaccinating girls. Wouldn't society be better protected if the boys were vaccinated, too?

As it turns out, the Food and Drug Administration recently wondered too. An FDA panel recommended the vaccine for boys -- but then a study out of the Harvard School of Public health found that this wouldn't be cost-effective. It all has to do with a complex formula, described this way by HealthDay News:

Other experts say Harvard failed to take some factors into account that make it worthwhile to vaccinate boys. then of course there are parents who worry about giving their daughters a new vaccine. In any case,  not all girls are vaccinated and women and older girls who move here from other nations also might not be protected. I certainly understand the need to figure out cost-effectiveness, but wonder how others are feeling about Gardasil.'

Photo: Mick Tsikas / EPA

-- Karin Klein

What's not to like about a proposed fee on California hospitals? The hospitals themselves support it, because it would bring in billions of dollars in federal funding to repay the hospitals and other health care providers for the medical care they give to poor people. The Times editorial board urges Gov. Schwarzenegger to see the logic and sign the bill to make it happen.

They call it overdraft protection, but there's little to protect the consumer from the multibillion-dollar flow of money to banks that charge a fee over and over and over again to debit-card users whose accounts can't cover their purchases. Often the fee is bigger than the purchase, but the customer simply doesn't realize the account is overdrawn. The Times calls on the Federal Reserve to fix this with rules that require better consumer information, a choice for customers who don't want the so-called protection and notification for the customer before that costly but unaffordable purchase is made.

And the board calls on Honduras to allow the return of President Manuel Zelaya -- with limited powers -- until the Nov. 29 election, though it also calls on the international community to make sure Zelaya understands he should not attempt to stay in power.

Let's admit this openly: Tuna aren't as awe-inspiring as whales. They don't spout in the middle of the ocean or do a slow dive that ends with the farewell wave of a giant tail. Nonetheless, they need protection after drastic overfishing, writes Joshua Reichert of the Pew Environment Group. On the Times Op-Ed page, Reichert argues that fishing caps haven't worked and that nothing but endangered-species status will save the Atlantic bluefin tuna.

Finally, energy journalist Richard Nemec writes that Los Angeles has been playing political musical chairs in determining leadership for the Department of Water and Power instead of hiring the experts it so desperately needs.

Photo: Gavin Newman / Greenpeace International / EPA

-- Karin Klein

Small-government conservative columnist Jonah Goldberg makes a startling argument on today's Op-Ed page: We should make the House of Representatives bigger. A lot bigger, in fact; Goldberg says a Congress with 5,000 members would shake up our nation's calcified two-party system and more closely approximate the kind of democracy the founding fathers intended.

UC Irvine School of Law Dean Erwin Chemerinsky, meanwhile, debunks arguments that the healthcare bills pending in the House and Senate would be unconstitutional. And obesity experts Kelly D. Brownell and David S. Ludwig argue in favor of a tax on sugar-sweetened sodas, which would help fund healthcare reform programs and lower healthcare costs by decreasing obesity and related ailments such as diabetes.

On the editorial page, the board urges the Obama administration to consider backing new elections in Afghanistan or a transitional government, unless monitors can determine that the country's Aug. 20 election was legitimate.

The editorial board also takes up a gun-rights case and argues, surprisingly enough, in favor of stronger protections for gun owners. Though the board favors measures to reduce gun violence, it thinks the Supreme Court should rule that the 2nd Amendment applies to states as well as the federal government. That's because allowing states to ignore this part of the Bill of Rights could undermine the requirement that they abide by others.

Finally, the board notes that Comcast Corp.'s proposal to buy NBC Universal cuts against the grain of recent media deals, and its effect on the marketplace may be limited. But it will be interesting to watch how the combined company's approach to the Internet might change.

* Cartoon by Rob Rogers / Pittsburgh Post-Gazette

The Times editorial board laments the departure of Guy Mehula, the man who oversaw the recent surge construction for the Los Angeles Unified School District. That program operated with an efficiency and competence rarely found at LAUSD, the board asserts, and those qualities are threatened by Superintendent Ramon C. Cortines' reported plans to supervise the unit more closely:

Elsewhere on the editorial page, the board defends Facebook's handling of a user-generated poll asking whether President Obama should be assassinated. And it urges lawmakers to grow spines and stop blocking the transfer of Guantanamo detainees to maximum security federal prisons in the U.S.

On the Op-Ed side of the fold, columnist Tim Rutten runs through the list of policy challenges facing President Obama -- the jobless recovery, rising health insurance premiums, the war in Afghanistan, the Iranian leadership's nuclear ambitions -- and finds no easy choices. Nina Hachigian, a senior fellow at the Center for American Progress, says the Chinese government is sending mixed signals about its willingness to play ball with international organizations to address global problems: And writer Kathryn Wilkens of Upland muses about the life and death of the mission fig tree that had anchored her garden for decades:

Insert your ironic comment about this article appearing in dead tree media here.

Illustration: Blair Thornley / For The Times

-- Jon Healey

The proposed mandate that everyone obtain health insurance may actually be unifying the left and right -- in opposition. I wrote a post yesterday about the conservative critique of the mandate (it's an attack on liberty). Today, our front page offers the liberals' complaint about the requirement, to wit, that it isn't accompanied by price controls on insurance premiums. The zippy headline on the Web version of the story is, "Mandate minus price controls may increase healthcare costs."

To which I say: You can't be serious. Price controls? I'm no economist, but I don't know of any successful efforts by government to restrain fast-growing prices by slapping caps on them. The House and Senate healthcare bills take the much more fruitful approach of attacking the perverse incentives that lead to overconsumption of medical services, promoting preventative medicine and trying to boost efficiency through the use of technology and scientifically sound treatments. They're not aggressive enough in these efforts, nor are they doing enough to harness market forces. But at least they're focusing on the roots of the problem. 

If you want a preview of how well price controls would work, consider Medicare. The federal government has tried for years to impose a form of price controls on Medicare -- it sets reimbursement rates at artificially low levels for many services. The low rates have reduced supply by persuading some providers to curtail or eliminate their Medicare caseloads. They've also been politically impossible to maintain. In 1997 Congress enacted the "sustainable growth rate" formula to dial back the rise in reimbursements, tying their annual growth to the increase in GDP. For the past several years, however, Congress has lifted the limits in the face of pressure from doctors, hospitals and seniors. And the healthcare reform bills would waive the formula again.

As my previous post pointed out, the main proponent of the individual mandate has been the insurance industry. With conservatives bailing and liberals demanding what amounts to a pound of flesh, you have to wonder how badly the industry still wants it.

-- Jon Healey